Local Public Health Systems To Compete With Medicaid Hmos

July 26, 1999|By BOB LaMENDOLA Health Writer

South Florida families on Medicaid will soon have a new choice for their medical care, one that state officials hope will keep them healthier.

In an experiment being watched statewide, three local public health systems are forming their own Medicaid network. It aims to give patients more preventative care than much-maligned Medicaid HMOs, while being more cost-efficient than individual doctors.

The South Florida Community Care Network hopes to attract 45,000 of the 450,000 Medicaid patients in Broward and Miami-Dade counties over the next year. State officials say it will compete strongly against HMOs and 1,500 doctors in the region now vying for those patients.

"The program is going to be graded," said Charles Kight, a Medicaid administrator overseeing the experiment. If it works, it would be expanded statewide.

"Can they increase the quality of care for our Medicaid recipients? Can they produce high satisfaction from patients and providers? Can they save taxpayers dollars?" Kight asked.

"We think they can do all of those," he said.

Medicaid advocate Jasmin Shirley Moore agrees.

The key is for the new network to sign up doctors in low-income neighborhoods where many Medicaid patients live, unlike HMOs, she said.

"If the network that is forming is going to be diverse, medically competent and accessible to the people, then I think it's going to be good for the patients," said Moore, a former public health nurse who is now a consultant targeting minority doctors.

The new program will be run jointly by the tax-subsidized North Broward Hospital District, Memorial Healthcare System, in south Broward County, and Jackson Memorial Hospital, in Miami.

The network, like an HMO, will require Medicaid patients to use its doctors and facilities, and will attempt to control costs.

The theory is that government health systems will be more liberal than for-profit health plans and better managers than individual doctors.

The HMO industry, which has about 450,000 of 1.5 million Medicaid patients, disagrees and opposed the experiment.

State officials had been looking for ways to trim costs of the $7 billion state-federal health program. They noted that Medicaid patients do not get as much routine and preventative care as they should, so they wind up with more serious and more costly illnesses.

The three government health systems proposed to offer better care for people with chronic illness such as diabetes, HIV, high blood pressure and childhood asthma.

They are prone to expensive complications if they don't keep up with their health. So, the new network will offer training programs and extensive follow-up efforts, mainly through phone calls and letters from nurses.

"Maybe it's just that the diabetics call in their blood count every day. If there's a problem, they come in," said John Benz, strategic development officer at Memorial.

Medicaid HMOs do some preventative care; individual doctors serving Medicaid patients have less time for it.

"Often, the only follow up the patients had was when they came for a doctor visit," said Frank McEldowney, business development director for the north Broward hospital district.

The new network, however, is expected to be the toughest competition for individual doctors, who treat 465,000 Medicaid patients.

Bob LaMendola can be reached at blamendola@sun-sentinel.com or 954-356-4526.